On 27 December 2017, the Cabinet of Ministers of Ukraine has presented a plan for implementation of the major reforms in the healthcare system for 2018 and has approved key documents for launching changes in primary healthcare provision.

Launching of the National Health Service of Ukraine

Today’s decision of the Government to approve the Provision on the National Health Service of Ukraine, the national insurer that will conclude agreements with healthcare institutions and purchase healthcare services provided to the population, is the key to implement the healthcare financing reform in Ukraine. The document will come into force after draft law No 6327 is signed by the President, thus influencing the timing of the reform implementation. In early January, a competition for the post of the head of the Service will be announced, and by July the Service will be established and will start its work.

The new financing system at the family doctors’ level will start its operation from the middle of the year

Starting from July 2018, primary healthcare institutions in the towns, hromadas and rayons, that will join the reform, will receive payments for healthcare services for each patient from the National Health Service of Ukraine. By this time, all healthcare institutions in the country will continue receiving funds through subventions from the local budgets. Secondary and tertiary healthcare institutions will be funded by subvention till the end of 2018.

In April, a national campaign “Choose Your Doctor” will start

It will be possible to choose the doctor and sign the Declaration from 1 April. By this time the signing of Declarations on the choice of the doctor will be carried out in a pilot mode.

In 2018, the state will pay for the basic package of services of family doctors, pediatricians, physicians under the new model

A new list of primary healthcare services and new requirements for the primary healthcare services’ provision are approved. This is a typical list of services for the European countries that includes consultations, appointments, certificates, preventive examinations and basic medical tests.

A set of tests included in the list will be gradually expanded, alike the “Available Medicines” programme.

The Government has simplified the process of medical practice opening

From now on, the procedure of getting a license for a medical practice in family healthcare or pediatrics at the Ministry of Health will take only 7 instead of 30 days. This is the first step, and the procedure will be soon even more simplified.

The “Available Medicines” programme has been expanded and launch of electronic prescriptions is under way

Next year, the “Available Medicines” programme will increase the number of free medicines – at least 10 medications – and 2 additional active substances for the treatment of cardiovascular diseases and type II diabetes will be included. In 2018, the state budget envisages 30% increase of programme funding – UAH 1 billion. In April an electronic prescription will be launched in several regions and in the town of Bakhmut, enabling patients to receive medicines not only in their own town, but also in other settlements. The Government also approved a number of technical changes related to the work and interaction of pharmacies, producers, distributors and budget funds managers: next year, electronic reporting will be introduced, and there will be an opportunity to sell the stocks of medicines at the prices of the previous period within 30 days after the definition of new ones.

Procedures for sending Ukrainians for treatment abroad are substantially simplified

The new regulation on sending Ukrainian citizens for treatment abroad introduces radically new principles of work of the Ministry of Health Commission and strictly regulates the entire procedure for sending sick Ukrainians to foreign hospitals for treatment. Today, the issues of the terms of cases’ consideration, choice of the hospital, delimitation of functions of local self-government bodies and Central Executive Authorities regarding direction for treatment abroad have been finally regulated. An improved funding mechanism and possibility of raising treatment funds from charitable foundations, funds from local budgets, and other sources not prohibited by the legislation, are foreseen.

It will enable not only to use budget funds efficiently, but also to keep pace with the process of sending people for treatment abroad. From now on, when a patient needs an urgent treatment, he/she can go to the foreign hospital from the moment of his/her registration by the commission.

Reference

Key dates of the reform of financing of healthcare system

• January 2018 – start of the preparatory period: the autonomy of primary healthcare institutions

The primary healthcare institutions will be the first to reorganise from the budget institutions into communal non-profit enterprises. Only under this condition will the institutions be able to conclude agreements with the National Health Service of Ukraine and receive direct funding from the State Budget for the services provided.

• April 2018 — start of the campaign on the choice of a primary healthcare provider (doctor)

The patient can choose any doctor, regardless of his/her place of registration or residence. A Declaration on the choice of a primary healthcare doctor, every Ukrainian must sign with his/her doctor, informs the state which institution or doctor should receive money for providing treatment services to a particular patient.

• June 2018 — launch of National Health Service of Ukraine
• July 2018 — start of funding of the primary healthcare institutions under the new model

Healthcare institutions will be able to join the reform only as an entire rayon, city or amalgamated hromada at once. This is due to the fact that subvention is transferred to the local budget and, accordingly, can be replaced completely for this budget, rather than for a separate institution.

• October and December 2018 — the second and third “windows of opportunities” for the introduction of primary healthcare institutions into the reform

The Parliament decided to leave both financing systems – a healthcare subvention and direct payments under the agreements with the National Health Service of Ukraine – during the transition period. Therefore, prior to the direct payments from the State Budget under the agreements with the NHSU, the primary link institutions (including autonomous ones) will be financed at the expense of the  healthcare subvention, as it used to be before. The institutions of the secondary and tertiary links will be funded by subvention throughout the whole 2018.

• 2019 — start of the reform at the level of a specialised healthcare (specialist doctors)
• 2020 — start of the reform at the level of highly specialised healthcare (inpatient treatment in hospitals)